Bottom Line:
The PRIH-I comprises 13 questions about patient-perceived incidents in hospitals, and can be easily and cost-effectively included in national patient-experience surveys with an acceptable increase in respondent burden.Although the missing-item rate and test-retest reliability were poor for several items, the hospital-level reliability was satisfactory for most of the items.The incident items contribute to a patient-reported incident index, with excellent data quality and hospital-level reliability.

Background: The objective of this study was to test the data quality, test-retest reliability and hospital-level reliability of the Patient-Reported Incident in Hospital Instrument (PRIH-I).

Methods: 13 incident questions were included in a national patient-experience survey in Norway during the spring of 2011. All questions and a composite incident index were assessed by calculating missing-item rates, test-retest reliability and hospital-level reliability. A multivariate linear regression on a global item regarding incorrect treatment was used to assess the main sources of variation in patient-perceived incorrect treatment at hospitals.

Results: Five of the 13 patient-incident questions had a missing-item rate of >20%. Only one item met the criterion of 0.7 for test-retest reliability (wrong or delayed diagnosis), seven items had a score of >0.5, while the remainder had a reliability score of <0.5. However, the reliability was >0.7 for six of 10 items tested at the hospital level, and >0.6 for the remaining four items. A patient-incident index based on 12 of the incident items had no missing data, the test-retest reliability was 0.6 and the hospital-level reliability was 0.85.

Conclusions: The PRIH-I comprises 13 questions about patient-perceived incidents in hospitals, and can be easily and cost-effectively included in national patient-experience surveys with an acceptable increase in respondent burden. Although the missing-item rate and test-retest reliability were poor for several items, the hospital-level reliability was satisfactory for most of the items. The incident items contribute to a patient-reported incident index, with excellent data quality and hospital-level reliability.

Mentions:
The reliability rating exceeded 0.7 for six out of 10 continuous items at the hospital level, ranging from 0.85 for the item about transfer of important information between health personnel to 0.70 for the item about unnecessary injury/problem related to surgery. The remaining four continuous items had a hospital-level reliability of between 0.6 and 0.7, while the hospital reliability was 0.85 for the incident index. With the exception of the item about control of identity, fewer than 200 respondents were needed for each hospital to reach the reliability criterion of 0.7. A reliability criterion of 0.9 would require very large hospital samples for all incident questions (range 256–1014), but the incident index and two items reach 0.9 with less than 300 respondents. Figure 1 shows the mean score for the patient-incident index by hospital, which varied from 0.54 for the best hospital to 1.68 for the worst.

Mentions:
The reliability rating exceeded 0.7 for six out of 10 continuous items at the hospital level, ranging from 0.85 for the item about transfer of important information between health personnel to 0.70 for the item about unnecessary injury/problem related to surgery. The remaining four continuous items had a hospital-level reliability of between 0.6 and 0.7, while the hospital reliability was 0.85 for the incident index. With the exception of the item about control of identity, fewer than 200 respondents were needed for each hospital to reach the reliability criterion of 0.7. A reliability criterion of 0.9 would require very large hospital samples for all incident questions (range 256–1014), but the incident index and two items reach 0.9 with less than 300 respondents. Figure 1 shows the mean score for the patient-incident index by hospital, which varied from 0.54 for the best hospital to 1.68 for the worst.

Bottom Line:
The PRIH-I comprises 13 questions about patient-perceived incidents in hospitals, and can be easily and cost-effectively included in national patient-experience surveys with an acceptable increase in respondent burden.Although the missing-item rate and test-retest reliability were poor for several items, the hospital-level reliability was satisfactory for most of the items.The incident items contribute to a patient-reported incident index, with excellent data quality and hospital-level reliability.

Background: The objective of this study was to test the data quality, test-retest reliability and hospital-level reliability of the Patient-Reported Incident in Hospital Instrument (PRIH-I).

Methods: 13 incident questions were included in a national patient-experience survey in Norway during the spring of 2011. All questions and a composite incident index were assessed by calculating missing-item rates, test-retest reliability and hospital-level reliability. A multivariate linear regression on a global item regarding incorrect treatment was used to assess the main sources of variation in patient-perceived incorrect treatment at hospitals.

Results: Five of the 13 patient-incident questions had a missing-item rate of >20%. Only one item met the criterion of 0.7 for test-retest reliability (wrong or delayed diagnosis), seven items had a score of >0.5, while the remainder had a reliability score of <0.5. However, the reliability was >0.7 for six of 10 items tested at the hospital level, and >0.6 for the remaining four items. A patient-incident index based on 12 of the incident items had no missing data, the test-retest reliability was 0.6 and the hospital-level reliability was 0.85.

Conclusions: The PRIH-I comprises 13 questions about patient-perceived incidents in hospitals, and can be easily and cost-effectively included in national patient-experience surveys with an acceptable increase in respondent burden. Although the missing-item rate and test-retest reliability were poor for several items, the hospital-level reliability was satisfactory for most of the items. The incident items contribute to a patient-reported incident index, with excellent data quality and hospital-level reliability.